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The COVID-19 pandemic has disrupted lives and livelihoods, and people already experiencing mental ill health may have been especially vulnerable.
Quantify mental health inequalities in disruptions to healthcare, economic activity and housing.
We examined data from 59 482 participants in 12 UK longitudinal studies with data collected before and during the COVID-19 pandemic. Within each study, we estimated the association between psychological distress assessed pre-pandemic and disruptions since the start of the pandemic to healthcare (medication access, procedures or appointments), economic activity (employment, income or working hours) and housing (change of address or household composition). Estimates were pooled across studies.
Across the analysed data-sets, 28% to 77% of participants experienced at least one disruption, with 2.3–33.2% experiencing disruptions in two or more domains. We found 1 s.d. higher pre-pandemic psychological distress was associated with (a) increased odds of any healthcare disruptions (odds ratio (OR) 1.30, 95% CI 1.20–1.40), with fully adjusted odds ratios ranging from 1.24 (95% CI 1.09–1.41) for disruption to procedures to 1.33 (95% CI 1.20–1.49) for disruptions to prescriptions or medication access; (b) loss of employment (odds ratio 1.13, 95% CI 1.06–1.21) and income (OR 1.12, 95% CI 1.06 –1.19), and reductions in working hours/furlough (odds ratio 1.05, 95% CI 1.00–1.09) and (c) increased likelihood of experiencing a disruption in at least two domains (OR 1.25, 95% CI 1.18–1.32) or in one domain (OR 1.11, 95% CI 1.07–1.16), relative to no disruption. There were no associations with housing disruptions (OR 1.00, 95% CI 0.97–1.03).
People experiencing psychological distress pre-pandemic were more likely to experience healthcare and economic disruptions, and clusters of disruptions across multiple domains during the pandemic. Failing to address these disruptions risks further widening mental health inequalities.
Nicolaides–Baraitser syndrome is a rare, neuro-developmental disorder caused by heterozygous pathogenic variants in the SMARCA2 gene, involved with chromatin regulation. Cardinal features include intellectual disability, short stature, microcephaly, triangular facies, sparse hair, brachydactyly, prominent interphalangeal joints and seizures. Genetic testing demonstrated a loss within SMARCA2 at 9p24.3 inclusive of basepairs 2094861_2141830 (hg19) in our patient. This case highlights a child with Nicolaides–Baraiter syndrome, a SMARCA2 gene deletion and a novel association of hypertrophic obstructive cardiomyopathy.
It is well established that migraine is a multifactorial disorder. A deep understanding of migraine should be based upon both the underlying traits and the current states affected by different physiological, psychological, and environmental factors. At this point, there is no framework fully meeting these criteria. Here, we describe a broader view of the migraine disorder defined as a dysfunctional brain state and trait interaction. In this model, we consider events that may enhance or diminish migraine responsivity based on an individual’s trait and state. This could provide an expanded view for considering how migraine attacks are sometimes precipitated by “triggers” and sometimes not, how these factors only lead to migraine attacks in migraine patients, or how individuals with an increased risk for migraine do not show any symptoms at all. Summarizing recent studies and evidence that support the concept of migraine as a brain state–trait interaction can also contribute to improving patient care by highlighting the importance of precision medicine and applying measures that are able to capture how different traits and states work together to determine migraine.
Lithium was first found to have an acute antimanic effect in 1948 with further corroboration in the early 1950s. It took some time for lithium to become the standard treatment for relapse prevention in bipolar affective disorder. In this study, our aims were to examine the factors associated wtih the likelihood of maintaining lithium levels within the recommended therapeutic range and to look at the stability of lithium levels between blood tests. We examined this relation using clinical laboratory serum lithium test requesting data collected from three large UK centres, where the approach to managing patients with bipolar disorder and ordering lithium testing varied.
46,555 lithium rest requests in 3,371 individuals over 7 years were included from three UK centres. Using lithium results in four categories (<0.4 mmol/L; 0.40–0.79 mmol/L; 0.80–0.99 mmol/L; ≥1.0 mmol/L), we determined the proportion of instances where, on subsequent testing, lithium results remained in the same category or switched category. We then examined the association between testing interval and proportion remaining within target, and the effect of age, duration of lithium therapy and testing history.
For tests within the recommended range (0.40–0.99 mmol/L categories), 84.5% of subsequent tests remained within this range. Overall 3-monthly testing was associated with 90% of lithium results remaining within range compared with 85% at 6-monthly intervals. At all test intervals, lithium test result history in the previous 12-months was associated with the proportion of next test results on target (BNF/NICE criteria), with 90% remaining within range target after 6-months if all tests in the previous 12-months were on target. Age/duration of lithium therapy had no significant effect on lithium level stability. Levels within the 0.80–0.99 mmol/L category were linked to a higher probability of moving to the ≥1.0 mmol/L category (10%) than those in the 0.40–0.79 mmolL group (2%), irrespective of testing frequency. Thus prior history in relation to stability of lithium level in the previous 12 months is a predictor of future stability of lithium level.
We propose that, for those who achieve 12-months of lithium tests within the 0.40–0.79mmol/L range, it would be reasonable to increase the interval between tests to 6 months, irrespective of age, freeing up resource to focus on those less concordant with their lithium monitoring. Where lithium level is 0.80–0.99mmol/L test interval should remain at 3 months. This could reduce lithium test numbers by 15% and costs by ~$0.4 m p.a.
The coronavirus disease 2019 (COVID-19) pandemic is having a well-documented impact on the mental health of front-line health and social care workers (HSCWs). However, little attention has been paid to the experiences of, and impact on, the mental health professionals who were rapidly tasked with supporting them.
We set out to redress this gap by qualitatively exploring UK mental health professionals’ experiences, views and needs while working to support the well-being of front-line HSCWs during the COVID-19 pandemic.
Mental health professionals working in roles supporting front-line HSCWs were recruited purposively and interviewed remotely. Transcripts of the interviews were analysed by the research team following the principles of reflexive thematic analysis.
We completed interviews with 28 mental health professionals from varied professional backgrounds, career stages and settings across the UK. Mental health professionals were motivated and driven to develop new clinical pathways to support HSCWs they perceived as colleagues and many experienced professional growth. However, this also came at some costs, as they took on additional responsibilities and increased workloads, were anxious and uncertain about how best to support this workforce and tended to neglect their own health and well-being. Many were professionally isolated and were affected vicariously by the traumas and moral injuries that healthcare workers talked about in sessions.
This research highlights the urgent need to consider the mental well-being, training and support of mental health professionals who are supporting front-line workers.
To describe a pilot project infection prevention and control (IPC) assessment conducted in skilled nursing facilities (SNFs) in New York State (NYS) during a pivotal 2-week period when the region became the nation’s epicenter for coronavirus disease 2019 (COVID-19).
A telephone and video assessment of IPC measures in SNFs at high risk or experiencing COVID-19 activity.
SNFs in 14 New York counties, including New York City.
A 3-component remote IPC assessment: (1) screening tool; (2) telephone IPC checklist; and (3) COVID-19 video IPC assessment (ie, “COVIDeo”).
In total, 92 SNFs completed the IPC screening tool and checklist: 52 (57%) were conducted as part COVID-19 investigations, and 40 (43%) were proactive prevention-based assessments. Among the 40 proactive assessments, 14 (35%) identified suspected or confirmed COVID-19 cases. COVIDeo was performed in 26 (28%) of 92 assessments and provided observations that other tools would have missed: personal protective equipment (PPE) that was not easily accessible, redundant, or improperly donned, doffed, or stored and specific challenges implementing IPC in specialty populations. The IPC assessments took ∼1 hour each and reached an estimated 4 times as many SNFs as on-site visits in a similar time frame.
Remote IPC assessments by telephone and video were timely and feasible methods of assessing the extent to which IPC interventions had been implemented in a vulnerable setting and to disseminate real-time recommendations. Remote assessments are now being implemented across New York State and in various healthcare facility types. Similar methods have been adapted nationally by the Centers for Disease Control and Prevention.
Whereas scholars have typically modeled climate change as a global collective action challenge, we offer a dynamic theory of climate politics based on the present and future revaluation of assets. Climate politics can be understood as a contest between owners of assets that accelerate climate change, such as fossil fuel plants, and owners of assets vulnerable to climate change, such as coastal property. To date, obstruction by “climate-forcing” asset holders has been a large barrier to effective climate policy. But as climate change and decarbonization policies proceed, holders of both climate-forcing and “climate-vulnerable” assets stand to lose some or even all of their assets' value over time, and with them, the basis of their political power. This dynamic contest between opposing interests is likely to intensify in many sites of political contestation, from the subnational to transnational levels. As it does so, climate politics will become increasingly existential, potentially reshaping political alignments within and across countries. Such shifts may further undermine the Liberal International Order (LIO); as countries develop pro-climate policies at different speeds and magnitudes, they will have incentives to diverge from existing arrangements over trade and economic integration.
Shows that secularism is a dividing line between the parties, thus suggesting that the United States is moving toward a confessional party system, in which religiosity–secularity is a dividing line between the parties. The religious–secular divide between Republicans and Democrats is illustrated through the use of data from party convention delegates, as well as from the mass public.
Considers the likely future of secularism as a fault line in American politics. Secularism is gaining ground, which suggests that it will feed further political polarization, and perhaps even lead to a confessional party system based on religious–secular differences. We also speculate that the conditions may be right for the creation of a new political movement – a Secular Left to parallel the Religious Right. Such a movement is not a certainty, however. Will the strategic candidates seek to mobilize the growing secular population? The chapter, and thus the book, concludes by suggesting that growing secularism need not mean more polarization, as politicians could seek common ground between religionists and secularists.
Uses a set of experiments to explore how voters react to political candidates who describe themselves with varying degrees of secularity, from a hard-edged version such as “atheist” to a softer statement like “I’m not particularly religious.” The results show that while voters are averse to candidates who express disbelief in God, they are open to candidates who describe their secularity in other ways.
Establishes the political origins of the secular surge by demonstrating that the recent rise in nonreligiosity has been caused, at least in part, by a political backlash against the Religious Right, and the infusion of religion into conservative politics more generally. Using a series of experiments, we show that exposure to religion-infused politics causes people to drop their religious identity.
Examines how personal secularism shapes public opinion where we would expect it to matter: the line between church and state, or public secularism. We explore the nuances in Americans' attitudes on church–state separation, including how both personal secularism and nonreligiosity shape attitudes toward the twin religious protections guaranteed by the First Amendment, protection of religious free exercise and protection from government establishment of religion. Our analysis speaks directly to the current debate over the meaning of religious liberty.
Describes the rising tide of secularism within the United States, including but not limited to the growth of the “Nones” – people without a religious affiliation. Also introduces a key concept in the book: the difference between nonreligiosity and secularism. The former is defined by the absence of religion (what you are not) while the latter refers to an affirmative embrace of a secular worldview (what you are).
American society is rapidly secularizing–a radical departure from its historically high level of religiosity–and politics is a big part of the reason. Just as, forty years ago, the Religious Right arose as a new political movement, today secularism is gaining traction as a distinct and politically energized identity. This book examines the political causes and political consequences of this secular surge, drawing on a wealth of original data. The authors show that secular identity is in part a reaction to the Religious Right. However, while the political impact of secularism is profound, there may not yet be a Secular Left to counterbalance the Religious Right. Secularism has introduced new tensions within the Democratic Party while adding oxygen to political polarization between Democrats and Republicans. Still there may be opportunities to reach common ground if politicians seek to forge coalitions that encompass both secular and religious Americans.
Demonstrates, with original data, that Americans are more secular than they appear. We do so by contrasting conventional measures of nonreligiosity (the absence of religion) with our new and novel measures of personal secularism – or a secular worldview. We use a variety of methods, quantitative and qualitative, to validate these measures, which are then employed throughout the book.
Illustrates how secularism is a potent predictor of public opinion that has, heretofore, been undetected. The chapter then digs deeper into the relationship between secularism, nonreligiosity, and politics. By employing the panel version of the Secular America Study that ran from 2010 to 2012 we test whether political views are more likely to lead to secular orientations or the other way around. The results show a backlash: politics drives people away from religion. But they also show that secularism drives political views, even on issues far removed from questions related to church and state. Secularists are firmly planted in the progressive wing of the Democratic Party.